OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Division of Independent Review Objective Review Assessment Survey

IC 264344 under ICR 202401-0915-004 · OMB 0915-0212.

Documents and Forms
Document Name
Document Type
Form and Instruction
Other-Public Burden Statement Screen
Other-Public Burden Statement Screen
Form and Instruction
Form and Instruction
Form
Form
Form
Form
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Division of Independent Review Objective Review Assessment Survey
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1.1 Screenshot Reviewer Instr DIR Review Assessment Survey form 1 - screenshot Reviewer instr.pdf Yes Yes Fillable Fileable
Form 2 Form Chair Q 1-5 FORM CHAIR Q 1-5.pdf Yes Yes Fillable Fileable
Form 1 FORM Reviewer Evaluation Q 1- 15 FORM Reviewer Evaluation Q 1- 15.pdf Yes Yes Fillable Fileable
Form and Instruction 1.2 FORM Reviewer Evaluation-Field Review Q 1 - 12 FORM Reviewer Evaluation-Field Review Q 1 - 12.pdf Yes Yes Fillable Fileable
Other-Public Burden Statement Screenshot Public Burden Statement Screenshot.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

2,300 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,300 0 2,300 0 0 0
Annual IC Time Burden (Hours) 575 0 575 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Original Generic Request Supporting Statement A - DIR Review Assessment Surve.docx 01/09/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.